How Are Late-Term Abortions Performed? It's A Straightforward Medical Procedure

When an unmarried woman known as "Jane Roe" filed a lawsuit in 1970 to challenge Texas laws criminalizing abortion, she likely didn't anticipate the long-term repercussions her court battle would have on America. Indeed, the U.S. Supreme Court's 1973 decision to legalize abortion in the landmark case of Roe v. Wade came full circle during a segment of the third and final presidential debate Oct. 19. The discussion — initiated by a question from debate moderator Chris Wallace — eventually narrowed to the topic of late-term abortions, with GOP candidate Donald Trump misrepresenting how late-term abortions are performed — and Democratic nominee Hillary Clinton giving an impassioned defense of Roe v. Wade that clearly articulated the difficult and often heartbreaking decision many women have to face.

It's been 43 years since Roe v. Wade, but the controversy over a woman's right to terminate her pregnancy has never faded from public consciousness. In the ensuing decades, the nation's highest court would repeatedly be asked to review cases related to abortion restrictions, with many opponents of the procedure working to get Roe v. Wade overturned completely. The issue becomes especially heated during presidential elections, since presidents are tasked with nominating new Supreme Court justices and a conservative or liberal majority on the court has the potential to significantly impact future rulings on abortion rights.

Further complicating the abortion debate is that many aspects of the procedure are often distorted, from what happens during an abortion — especially during the later stages of pregnancy — to how common late-term abortions really are.

Myths about late-term abortion are dangerous and misconstrue what patients really experience, so here's the truth: Third-trimester abortions are illegal in most states, and abortions after the 20th week of pregnancy are incredibly rare. According to the Guttmacher Institute, just 1.3 percent of abortions occur at the 21st week or later. The vast majority of abortions (more than 98 percent) are performed within the first 12 weeks of pregnancy, aka the first trimester. No abortions are performed in the ninth month of pregnancy, as Trump claimed — that would often be referred to as an emergency C-section or induced labor, which happens in cases where the fetus might be in distress or the mother's life could be threatened if she carries the child to term.

Depending on the state of pregnancy, late-term abortions are performed in one of two ways, known as dilation and evacuation (D&E) and dilation and extraction (D&X), according to the American Pregnancy Association. Neither method involves "ripping babies out of wombs" — as articulated by Trump during the debate — nor is the fetus alive during such procedures. According to the American Pregnancy Association, the step-by-step process of a D&E is as follows:

Twenty-four hours prior, the provider inserts a dilator into the patient's cervix. (This helps to open the cervix and reduce its risk of injury.) If the patient's pregnancy has passed 21 weeks + 6 days of gestation, an injection known as feticide is given to stop the fetus' heartbeat and ensure it isn't alive during the procedure.

An antibiotic is provided to help prevent infection. The patient either receives a numbing medication or is placed under general anesthesia.

When the procedure begins, a tenaculum is used to keep the cervix and uterus in place. The cervix is further dilated using cone-shaped rods of increasing size.

A cannula (long tube) is then inserted into the uterus. The cannula is attached to a bottle and a pump that provides a vacuum and evacuates tissue away from the uterine lining. If necessary, forceps may be used to remove larger pieces of tissue.

A curette (a curved surgical instrument) is used to scrape the lining to make sure no residual tissue is left behind. A final suctioning may also be performed.

The D&X process is somewhat similar, but differs in others because the pregnancy is further along. A D&X is typically performed after a late-term miscarriage, when the presence of severe fetal anomalies is detected, or when the life of the mother is at risk. After the dilator is inserted, the patient's water should break a couple of days later, at which point they return to their provider for the rest of the procedure. The fetus is rotated and forceps are used to pull part of the fetus through the birth canal.

The provider then makes a small incision at the base of the fetus' skull to allow a suction catheter inside. Cerebral material is removed to facilitate the full extraction of the fetus.

According to Planned Parenthood, the cost of a late-term abortion can be as much as $2,000, if not higher, presenting a real service barrier for women in the most dire of circumstances. Yet understanding how late-term abortions are performed can help shed some light on how difficult and complicated the decision to have a late-term abortion actually is. According to Dr. Susan Robinson, one of the four remaining late-term abortion providers in the entire country, it's not one women take lightly:

I think that the public perceives, first of all, that late abortion could be completely eliminated if people would only get their act together and have their abortions earlier, which is completely untrue. I also think that people assume that women do this casually — that they’ve known they were pregnant for 30 weeks and then were on their way down to the hair salon and they saw the abortion clinic and they decided to just walk in to avoid the inconveniences of motherhood. That also is completely untrue. No matter how available birth control and first-trimester and second-trimester abortion is, you are always going to have the need for later abortions. A woman would never do this casually. The procedure lasts three or four days, and is fairly disagreeable.